From the editor

This Field Exchange special issue on Urban
Food Security and Nutrition aims to
provide some insights into the learning
and experience of a broad range of agencies,
and highlight some of the remaining gaps in
knowledge and areas for research and development.
This special edition focuses on programmes
responding to rapid and slow onset natural disasters
and displacement. The research, evaluations,
news and views have been carefully selected to
showcase the type of work that is being developed,
but it is not a comprehensive body of work;
rather a snapshot of current thinking and practice.
In a couple of editions time, ENN will produce a
special Syria edition, elaborated in a news piece on
page 48, which will deal with refugee urban populations
and host communities caught up in crisis.

As of 2008, the majority of the world’s population
lives in urban areas*. By 2030, over 60% of the world’s
population will live and work in urban environments.
The speed and scale of urbanisation today are far
greater than ever in the past, overstretching governments
and the international community’s capacities.
This implies overwhelming new challenges for cities
in poorer countries; they will need to build new urban
infrastructure – houses, power, water, sanitation,
roads, commercial and productive facilities – more
rapidly than cities anywhere before. The bulk of urban
population growth is likely to be in smaller towns and
cities, which lack the political capital, capacities and
resources to cope with rapid urbanisation.

Sub-Saharan Africa is the world’s fastest urbanising
region and has the highest proportion of slum**
dwellers (72% of its urban population). Asia is the
region that will host the highest number of new
urban dwellers, rising from 1.36 billion to 2.64 billion
by 2030. In Latin America and the Caribbean, rapid
urbanisation started in the 1960’s and it is now the
most urbanised region in the world, with 78% of its
population living in urban areas1.

Urban poverty and vulnerability are concentrated
in slums. One billion people already live in slums
(15% of the total of the worlds’ population of 7
billion); by 2030, this number will double. The United
Nations Millennium Declaration articulates the
commitment to improve the lives of at least 100
million slum dwellers by the year 2020 – Target 11 of
Goal No 7.

As population and poverty urbanises, so do disaster
risks and humanitarian crises. The global
assessment report on disaster risk reduction identifies
urbanisation as one of the three key drivers of
future disaster risk2. Whereas rapid and uncontrolled
urbanisation is constructing escalating risks, the
number and vulnerability of at-risk populations are
also rising. Haiti’s earthquake has demonstrated that
urban disasters’ scale and complexity defy humanitarian
actors, with their accumulated experience in
rural areas, to renovate their strategies and tools.

This growth is in the context of a global economic
downturn, sustained food price rises and reoccurring
complex emergencies. Urban food insecurity and
malnutrition are rarely monitored or captured by
early warning systems, and data is not disaggregated
at the level of urban slums. Although urban food
security and nutrition programmes are emerging,
they are struggling to raise their profile and strategically
engage donors.

massive IDP and refugee influxes in Beirut,
Amman, Bamako due to conflict, and in Nairobi
and Addis due to the indirect effect of climate
change and drought

political unrest in Harare and Gaza

landslides in La Paz and Guatemala city

In the coming years, there are both rapid and slow
onset urban emergencies predicted, including an
earthquake that will affect the Kathmandu valley and
beyond, and a burgeoning slum population across
Sub-Saharan Africa.

However, cities are also engines of growth and loci
of social, cultural and political dynamics that can
leverage rural, national and global level change – as
demonstrated by the democratisation movements
during the Arab Spring in 2011, in Africa in the 1990’s
or in Latin American in the 1980’s. Cities are economic
and cultural magnets for migrants in search of
economic opportunities or freedom from oppressive
social or gender norms. Cities are the markets where
food consumption, distribution and processing
patterns set the rules for food producers. Cities are
the first contributors to, and potential first victims of,
climate change and environmental depredation.

Many international non-governmental organisations
(INGOs) have been running small scale urban
programmes over the last 10 years, but approaches,
skills, learning, policy and funding is in its infancy
compared to the rural programmes where there is
experience and learning from the last 70 years. There
have been the assumptions that markets are integrated,
labour opportunities are widely available,
urban spaces enable access and there is availability of
food and health care. This may be the case for some
urban dwellers, but as urban slums grow (they make
up around 60% of Nairobi as described in the field
articles from Kenya in this edition), and population
densities rise (around a million people live in 1 square
mile in cities like Mumbai and Manila), there are
vulnerable households that cannot meet their immediate
needs and as a result become acutely food
insecure and malnourished. The Save the
Children/NutritionWorks (2012) review of food security
and nutrition in the urban poor is reviewed in this
edition and further discusses these issues (page 28).

Challenges

There have been a large number of papers written on
the challenges of urban programming and how it
differs from rural programming in its complexity. However, there are very few guidelines that translate
the challenges into adapted approaches to urban
programme and policy. What is clear is that we must
adapt rural approaches to differing urban contexts,
understanding that ‘communities’ do not exist in the
same way as in rural areas, that there are multiple
stakeholders and that we cannot hope to scale up to
meet the needs of the whole city. Therefore, we need
to invest more in strengthening partners and states
capacity to respond, to work hand in hand with
development actors, utilising skills that humanitarian
agencies do not typically possess such as power
analysis and governance skills, as well as strengthening
our risk analysis and disaster preparedness to
ensure that we can best organise our meagre
resources over large and complex spaces. These
issues are touched upon in a 2012 review by ALNAP
of lessons learned from urban emergencies,
summarised in this issue (page 47).

Preparedness

Although preparedness is not a recognised strength
of humanitarian agencies, it is essential in working
alongside communities to build resilience and ensure
a division of resources, labour and prioritisation for
vulnerable urban communities. Good risk analysis
should include a full power analysis and will provide
the opportunity to link humanitarian and development
programming in a ‘one programme approaches’
that reduce silos and ensures more effective
programming. The complexities of power relations in
urban settings can be immense, a great insight is
provided in an article about ‘gatekeepers’ to aid in
Mogadishu by the Somalia Cash Consortium (page
25). Few organisations have urban strategies, but
where they do exist (e.g. Oxfam GB 2012) there is
generally agreement that there should be a governance
framework for interventions with a strong
focus on working with the state rather than direct
service provision.

Slow onset & triggers

Although humanitarian imperatives dictate that
humanitarian responses reflect need, this has not
been the case for slow onset or hidden urban emergencies.
Rapid onset urban emergencies normally
receive good media coverage and funding, but urban
contexts affected by food price rises, an influx of
refugees or internally displaced people (IDPs), or
where there is a subtlety changing political or conflict
situation, have seen little or no urban specific funding. Current early warning systems or national data often
does not capture the vulnerability and seasonality of
changing food insecurity and malnutrition in slums,
and this lack of data makes it difficult to demonstrate
humanitarian need. The nature of slums means that
they are often not formally recognised by
Governments, as doing so would require the state to
provide services, infrastructure and safe habitats. So
capturing this data will be both political and also
require a change in triggers or cut-offs applied in rural
areas. For example, a global acute malnutrition (GAM)
rate of 8% in a slum may not exceed the threshold for
emergency response, but due to the population
concentration, may mean that there is the same
number of malnourished children as in a rural area.
These issues are further discussed in a review of urban
food security targeting methodology and emergency
triggers (Oxford Policy Management (OPM), Oxfam GB,
Concern International, ACF International) on page 30.

Assessments and analysis

Although ACF have developed guidelines for the
assessment of sustainable livelihoods and urban
vulnerabilities (summarised in this issue), they have
not been widely utilised by the international community.
Analysis is severely hampered by the lack of
disaggregated data for food security and nutritional
indices, although where data does exist it is clear that
there are some urban slums where vulnerability is as
bad as or worse than rural areas within the same
countries. The Food Security Cluster Urban Working
Group is reviewing tools and guidelines and working
to coordinate different agency approaches, but in the
meantime there is no consensus on assessment
approaches or triggers for analysis and this urgently
needs addressing. An article by Concern Worldwide
and the African Population and Health Research
Centre (APHRC) Kenya shares the findings of operational
research in Kenya to identify indicators that can
help detect the ‘tipping point’ from chronic need to
crisis in vulnerable urban populations. Their experience
demonstrates how unpredictable and heterogeneous
urban populations are. This work has been
undertaken as part of the Indicator Develop-ment for
Surveillance of Urban Emergencies (IDSUE) project, a
five year research study funded by the USAID Office of
U.S Foreign Disaster Assistance (OFDA).

Targeting

Evaluations have shown that community based
targeting, which is commonly used in rural areas, has
a high exclusion error when used in urban areas, as
outlined by the Oxfam evaluation from Nairobi, Gaza
and Port au Prince PAGE 30 This is for a number of
reasons including the lack of homogeneity, high
population concentrations, multiple stakeholders,
and distances within cities is further complicated by
criminal gangs, corrupt bureaucracy and business
people, and groups that do not wish to be identified
such as IDP’s and refugees. Initial work by ACF,
Concern and Oxfam has explored other approaches to
targeting in urban contexts (page 30). This is another
area that needs urgent attention and consensus to
ensure a multi-agency approach can be reached.

Interventions

From urban interventions, analysis and programme
evaluations over the last 10 years, it is clear that cash
transfers are very effective means of meeting immediate
needs in urban contexts where everything from
access to toilets, water, rent, transport, electricity,
education and health needs to be purchased (Oxfam
evaluation, page X). For example, vulnerable households
in Nairobi will spend up to 85% on food, water
and energy purchases, leaving little for rental, health,
sanitation and education. Cash transfers can be effective
vehicles for piloting social protection models
alongside Governments and enabling this modelling
to influence policy and provision of social protection to a broader group of urban poor. This has been done
in the Oxfam Nairobi programme in urban settlements,
shared in a field article (see page X). Urban
evaluations show that regular cash transfers not only
improve food security but also boost social capital
and can empower women during cash transfer
programmes to play a more active financial role
within the household. This shift in the gender
dynamic can be maintained if the programme incorporates
strategies to do so.

Nutrition and food security

The main determinants of food, livelihood and nutrition
security are the same for urban and rural areas.
However, there is a wide variation in the factors that
affect these determinants. For example, urban households
are more dependent on food purchase, which, if
they have sufficient purchasing power, can lead to a
more varied diet and higher reliance on ‘ready-made’
and fast foods, compared to rural households. Food
access has a direct impact on dietary diversity and has
been seriously affected by rising food and fuel prices,
conflict, and the primary or secondary effect of natural
disasters in urban areas across the globe.

Poor female-headed urban households or those
with high dependency ratios tend to have a dietary
diversity equal to that of the rural poor, however existing
tools for analysis, such as food consumption
scores, tend to be misleading in urban areas where
diets may appear diverse, but quantities of dairy
products or meat consumed might be negligible. As
the urban poor tend to be dependent on income from
precarious informal sector jobs that rarely meets their
consumption needs, they are more likely to employ
risky coping mechanisms, including high levels of
debt. Women are more likely than men to have less
secure and irregular jobs that are not subject to
labour laws and do not offer social or medical benefits.
This affects breastfeeding, infant feeding and
child care practices, especially for those without
family support who must adapt their work patterns or
use poor quality childcare. A gender aware perspective
is reflected in a research article by the Royal
Tropical Institute (Netherlands) and the Bondo
University College (BUC) that describes a study to
profile the causes of undernutrition in a Kenyan urban
slum (Kisumu) identifying needs and strategies to
improve child nutrition from women’s perspective
especially.

Over-crowding, poor water and sanitation, pollution,
open sewerage and contamination are
commonplace in informal settlements and slums.
They have a significant impact on child and household
health. Where urban data has been
disaggregated by wealth group or studies have
focused on the urban poor, high rates of undernutrition
(both acute and chronic malnutrition) have been
recorded for children under 5 years of age, which are
comparable with or higher than the rates in rural
under 5 year olds. Data that exists for urban poor
women reveals high rates of undernutrition
combined with rising levels of overweight or obesity
in some cases, reflecting the ‘double burden of malnutrition’
(this is reflected in the Save the
Children/NutritionWorks review cited earlier that
includes a summary case study from Bangladesh).
Rising to the challenge, the increased volume of
humanitarian programmes in urban settings has been
met by innovative and varied programming in many
diverse contexts from cash and voucher programmes
in Haiti, Democratic Republic of Congo (DRC) and the
Philippines (reflected in articles by ACF) to rooftop
gardening and aquaponics in Gaza (shared by FAO) to
rabbit rearing in Gaza (Oxfam programming).

Malnutrition – wasting and stunting – is a daily
reality of impoverished urban populations. This is
often a ‘hidden’ problem, as reflected in an article by ALIMA on their early experiences of an urban
programme in Chad that has been inundated with
admissions for treatment of malnutrition (page 68).
Routine screening for stunting as well as wasting is
one recommendation from MSF emerging from
research in an urban slum in Bangladesh (page 24).
Rollout of integrated management of acute malnutrition
in urban contexts is increasingly a priority for
governments, such as in Kenya (see the news piece by
UNICEF, Ministry of Health Kenya and Concern), and
reflected in service expansion (as reflected in an article
by Concern Worldwide). An article by the Coverage
Monitoring Network ‘debunks’ some of the myths that
surround access and coverage of severe acute malnutrition
treatment in urban contexts, while a research
piece by Ernest Guevarra, Saul Guerrero and Mark
Myatt explores considerations around coverage standards
for selective feeding prog-rammes. These all
point to the significant caseload of malnutrition in
urban settlements and slums that often remains
below the ‘emergency’ radar.

Donors

Currently donors are primarily funding rapid onset
short term urban responses, but are reluctant to
engage in slow onset crisis as they feel that urban
vulnerability is primarily chronic. The large donors are
yet to develop urban funding strategies and although
there is interest in this area, progress is slow. This is
another key area for focus, as without clear consensus
on what constitutes an urban emergency and what
the exit strategy will be, then urban interventions will
continue to be patchy and disconnected. An interesting
article in this edition shares experiences from a
donor perspective (Swedish International
Development Cooperation Agency (SIDA)), through
an evaluation by Development Initiatives of a SIDA
funded emergency programme in Kenya. One of the
key lessons was the need to link humanitarian funding
to extend the gains of emergency projects.

Urban programmes require a much greater focus
on political literacy, power analysis, negotiation skills,
security analysis and management, land policies,
informal tenure, urban planning, knowledge of urban
markets, private sector engagement, and use of information
communication technology, social media and
mass communication, than is typically the case in
rural humanitarian responses. Donors and the international
community will be required to work very
closely together to ensure that the additional skills
required for urban programme and policy are
captured.